Comparison of clinical and neuropathologic diagnoses of Alzheimer’s disease in 3 epidemiologic samples

Plassman, Brenda L.; Khachaturian, Ara S.; Townsend, Jeannette J.; Ball, Melvyn J.; Steffens, David C.; Leslie, Carol E.; Tschanz, JoAnn T.; Norton, Maria C.; Burke, James R.; Welsh-Bohmer, Kathleen A.; Hulette, Christine M.; Nixon, Randal R.; Tyrey, Mary; Breitner, John C.S.

doi:10.1016/j.jalz.2005.11.001

« Previous Next »Alzheimer's & Dementia: The Journal of the Alzheimer's Association
Volume 2, Issue 1 , Pages 2-11, January 2006

Comparison of clinical and neuropathologic diagnoses of Alzheimer’s disease in 3 epidemiologic samples

Brenda L. Plassman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Corresponding author. Tel.: 919-682-6722; Fax: 919-687-0424.
Ara S. Khachaturian
- Khachaturian and Associates, Potomac, MD, USA
Jeannette J. Townsend
- Department of Pathology, University of Utah Health Science Center, Salt Lake City, UT, USA
Melvyn J. Ball
- Section of Neuropathology, Oregon Health and Science University, Portland, OR, USA
David C. Steffens
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
Carol E. Leslie
- College of Family Life, Utah State University, Logan, UT, USA
JoAnn T. Tschanz
- Department of Psychology, Utah State University, Logan, UT, USA
- College of Family Life, Utah State University, Logan, UT, USA
Maria C. Norton
- Department of Psychology, Utah State University, Logan, UT, USA
- College of Family Life, Utah State University, Logan, UT, USA
James R. Burke
- Department of Neurology, Duke University Medical Center, Durham, NC, USA
- Joseph and Kathleen Bryan Alzheimer’s Disease Research Center, Duke University Medical Center, Durham, NC, USA
Kathleen A. Welsh-Bohmer
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
- Joseph and Kathleen Bryan Alzheimer’s Disease Research Center, Duke University Medical Center, Durham, NC, USA
Christine M. Hulette
- Department of Pathology, Duke University Medical Center, Durham, NC, USA
- Joseph and Kathleen Bryan Alzheimer’s Disease Research Center, Duke University Medical Center, Durham, NC, USA
Randal R. Nixon
- Section of Neuropathology, Oregon Health and Science University, Portland, OR, USA
Mary Tyrey
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
John C.S. Breitner
- VA Puget Sound Health Care System and the Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA

Abstract

Background

Studies of dementia in populations avoid many of the selection biases in clinical samples but require special evaluation and diagnostic methods to obtain high participation rates. To address this issue, we developed a unique in-home dementia assessment. We assessed validity of these assessments using neuropathologic confirmation of the clinical diagnosis in 3 epidemiologic samples.

Methods

Subjects were 175 participants in 3 ongoing studies of dementia. Two were population based and identified dementia by cognitive screening. The third study sought volunteers via advertisements. Dementia evaluations were then conducted at the participants’ residences by specially trained nurses and psychometricians. Evaluation results were interpreted, and preliminary diagnoses were assigned by a geropsychiatrist or neurologist and a psychologist. Final diagnoses were assigned by a consensus panel of neurologists, geropsychiatrists, and psychologists. We compared the clinical diagnoses with the gold-standard neuropathologic diagnoses for those participants who subsequently underwent autopsy.

Results

Among the demented, the sensitivity of a clinical diagnosis of probable or possible Alzheimer’s disease (AD) was 93% across the 3 studies. The rate of overall diagnostic agreement was 81%. Measures of agreement did not differ meaningfully across varying levels of dementia severity.

Conclusions

Rates of neuropathologic confirmation for clinical AD diagnoses in these studies were similar to those reported from clinic-based samples. These results support the validity of clinical diagnoses of AD from a structured in-home assessment of community dwelling and institutionalized individuals using relatively economical methods of dementia screening and assessment.

Keywords: Alzheimer’s disease , Dementia , Diagnosis , Neuropathology , Epidemiology